Perioperative effects of alpha-stat versus ph-stat strategies for deep hypothermic cardiopulmonary bypass in infants^{, , , ,}

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• 作者：Adre J. du Plessis ; Richard A. Jonas ; David Wypij ; Paul R. Hickey ; James Riviello ; David L. Wessel ; Stephen J. Roth ; Frederick A. Burrows ; Gene Walter ; David M. Farrell ; Amy Z. Walsh ; Christine A. Plumb ; Pedro del Nido ; Redmond P. Burke ; Aldo R. Castaneda ; John E. Mayer Jr. ; Jane W. Newburger
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：1997
• 出版时间：December 1997
• 年：1997
• 卷：114
• 期：6
• 页码：991-1001
• 全文大小：1106 K

文摘

Objectives: In a randomized, single-center trial, we compared perioperative outcomes in infants undergoing cardiac operations after use of the alpha-stat versus pH-stat strategy during deep hypothermic cardiopulmonary bypass. Methods: Admission criteria included reparative cardiac surgery, age less than 9 months, birth weight 2.25 kg or more, and absence of associated congenital or acquired extracardiac disorders. Results: Among the 182 infants in the study, diagnoses included d-transposition of the great arteries ( n = 92), tetralogy of Fallot ( n = 50), tetralogy of Fallot with pulmonary atresia ( n = 6), ventricular septal defect ( n = 20), truncus arteriosus ( n = 8), complete atrioventricular canal ( n = 4), and total anomalous pulmonary venous return ( n = 2). Ninety patients were assigned to alpha-stat and 92 to pH-stat strategy. Early death occurred in four infants (2 % ), all in the alpha-stat group ( p = 0.058). Postoperative electroencephalographic seizures occurred in five of 57 patients (9 % ) assigned to alpha-stat and one of 59 patients (2 % ) assigned to pH-stat strategy ( p = 0.11). Clinical seizures occurred in four infants in the alpha-stat group (4 % ) and two infants in the pH-stat group (2 % ) ( p = 0.44). First electroencephalographic activity returned sooner among infants randomized to pH-stat strategy ( p = 0.03). Within the homogeneous d-transposition subgroup, those assigned to pH-stat tended to have a higher cardiac index despite a lower requirement for inotropic agents; less frequent postoperative acidosis ( p = 0.02) and hypotension ( p = 0.05); and shorter duration of mechanical ventilation ( p = 0.01) and intensive care unit stay ( p = 0.01). Conclusions: Use of the pH-stat strategy in infants undergoing deep hypothermic cardiopulmonary bypass was associated with lower postoperative morbidity, shorter recovery time to first electroencephalographic activity, and, in patients with d-transposition, shorter duration of intubation and intensive care unit stay. These data challenge the notion that alpha-stat management is a superior strategy for organ protection during reparative operations in infants using deep hypothermic cardiopulmonary bypass. (J Thorac Cardiovasc Surg 1997;114:991-1001)